This has been on my mind and Happy Hospitalist's post http://thehappyhospitalist.blogspot.com/2009/02/dr-nurse-pa-perspective-and-your.html got me thinking about the whole thing.
I am board certified in my field and I completed a 2 year hospital based residency, but nothing that compares to physician residencies. Because of my training and my interests I see a fair number of medically compromised patients. There are times I need to consult with my patient's primary care physician before embarking on a proposed treatment plan. When I consult with a physician it is not to ask permission to treat the patient, but to see if there are any potential landmines with my choice of meds or procedures. There have been a few times as of late that I have gotten a reply from a PA. I'm sorry, but I will not accept those consult replies.
My treatment plan will be based on my judgement and the input of the patient's physician not a mid level provider. When the patient is in my office, I am wholly responsible for their care and the outcome of any treatment. I could not defend any decision made by one of my colleagues based on input by anyone other than an MD or DO and I don't think it would be defensible in court.